Hormone replacement therapy: Estrogen, Progesterone, and Testosterone. The important message that people need to get is that there is no clear right or wrong approach to hormone replacement, because we just don’t have the research.
I believe that no matter how much research is done, there will probably never be a universal, comprehensive, “clear right or wrong approach to hormone replacement.” Each woman is unique and presents the challenge of being her own long term research study.
What is clear to me is that taking the trouble to work with oneself and to find a doctor who can really help is worth the effort. In a review of menopausal hormone therapy in inaugural issue of the Journal of Women’s Health, Dr. Trudy Bush, an epidemiologist at Johns Hopkins University, summarized:
“The scientific evidence to date supports … . the concept of hormonal therapy for use by most postmenopausal women.. . to maintain an active and full life.”
People talk about hormone replacement therapy (HRT) as if it were a simple, complete answer to the problem of hormone depletion, but as much as we might wish, we cannot exactly reproduce the full, complex hormonal tapestry of our reproductive years.
Having said that, though, with hormone supplemental therapy, we can provide our bodies with judicious amounts of estrogen and testosterone, to nourish and maintain the function of our tissues to the extent that aging allows. The unique role of supplemental testosterone for maintaining vital and sexual energy must challenge the automatic assumption that HRT means estrogen and progesterone.
For many women, HRT means estrogen, progesterone and testosterone. Today, most women know that supplemental estrogen can be used to relieve the traditionally familiar symptoms of menopause, which include hot flashes, night sweats, genital dryness, genital atrophy, mood swings, memory fuzziness, and insomnia. The two most important health reasons to consider using supplementary estrogen and progesterone are to protect our cardiovascular system and our bones.
Until menopause, women have statistically fewer heart attacks and strokes than men. This is due to the beneficial ef-fects of estrogen on the lipids (fats) in the blood. At menopause, when the ovaries stop producing substantial estrogen, this protection that women have had is no longer available. After menopause, women and men have about the same levels of estrogen and the same incidence of heart attacks and strokes.
This statistic is worth repeating: Studies show that postmenopausal women who take supplementary estrogen reduce their risk of heart attack and stroke by 50 percent. Adding testosterone to the hormonal regimen has been shown not to interfere with the favorable effect of estrogen on cholesterol. In fact, testosterone contributes its own benefits to blood vessels and blood-clotting factors, further protecting a woman’s cardiovascular system.
Supplementary estrogen is essential for many women to prevent osteoporosis. Most women know that adequate dietary calcium, vitamin D, and weight-bearing exercise are important contributors to the health of our bones. However, for women with a genetic tendency to develop osteoporosis, diet and exercise without supplementary estrogen have been shown not to be significantly effective. Adequate supplementary estrogen for these women can be crucial in maintaining their bone density.
Testosterone and progesterone have also been shown to contribute substantially to the maintenance of bones. Researchers in the Netherlands recently published their findings that progestins help to build bones by a different mechanism than estrogen, and consequently make an independent contribution to the prevention of osteoporosis.
In addition, Dr. Joel Finkeistein and his coworkers at Massachusetts General Hospital in Boston have published several papers on their work with men whose bones were weakened as a result of testosterone deficiency caused by an unusual metabolic genetic condition, and reported that significant increases in bone density occurred when these men were treated with supplementary testosterone.
“I take hormones for menopause. How long do I have to take them?”
The beneficial effects of estrogen (to protect bones and blood vessels and to maintain the health of genital tissues, for example) depend on taking it. If you stop the estrogen, you stop the benefit: If you have testosterone deficiency and are taking supplemental testosterone, stopping the testosterone will likewise stop the benefit. Of course, the same reasoning applies to the benefits of progestins.
The truth about side effects is that there is no substitute for patient and individual attention to the details of the way each woman’s body responds to hormones. No routine schedule of HRT will work for every woman, but with experience, intelligence, flexibility, and care, a recipe for hormone replacement that both improves a woman’s quality of life and protects her long term health can be created.